Is it true insurance companies pay NPs as much as physicians in Oregon?

[Tom4705]

Hey everyone,

i've been reading about a law titled HB 2902 in Oregon, which says that insurance companies must reimburse NPs and PAs at the same rate as physicians when they do the same work and bill under the same codes. However, I've read different articles saying very different things about the legal status of the law. My question is, does anyone know if this is true? Are NPs in Oregon making as much as doctors when they bill for the same thing? If this is true, I find it astonishing. Any information on this would be greatly appreciated.

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[Mad Jack]

Yes. Next question.

 

[Tom4705]

Yes. Next question.

Do you know of anyone doing this? When I look up the standard salary of a NP in Oregon it still gives a lower figure than a MD in the same specialty.

 

[Mad Jack]

Do you know of anyone doing this? When I look up the standard salary of a NP in Oregon it still gibes a lower figure than a MD in the same specialty.

NPs tend to be far less productive than physicians, on average. If you're making the same amount per patient but seeing two patiemts an hour instead of three and work 40 hours a week instead of 55, you're going to make a lot less money for a practice and get paid a lot less. Physicians also tend to take on more complicated patients, so you end up billing higher codes than the average NP. Basically, equal pay per code does not equal equal income for the practice when you're seeing different amounts and types of patients

 

[Tom4705]

NPs tend to be far less productive than physicians, on average. If you're making the same amount per patient but seeing two patiemts an hour instead of three and work 40 hours a week instead of 55, you're going to make a lot less money for a practice and get paid a lot less. Physicians also tend to take on more complicated patients, so you end up billing higher codes than the average NP. Basically, equal pay per code does not equal equal income for the practice when you're seeing different amounts and types of patients

Fair enough, although I was thinking particularly of Psych NPs vs Psychiatrists who would see the same number of patients and bill for the same thing.

 

[Mad Jack]

Fair enough, although I was thinking particularly of Psych NPs vs Psychiatrists who would see the same number of patients and bill for the same thing.

Take it from someone in psych, they don't see the same number or type of patients as psychiatrists. Our PMHNPs would typically see 12 patients per day, with 90 minute intakes, while psychiatrists would see 20 patients per day with 45 minute intakes.

 

[psychnurse]

Fair enough, although I was thinking particularly of Psych NPs vs Psychiatrists who would see the same number of patients and bill for the same thing.

One key reason is that many PMHNPs (or NPs in general) have very little concept of finances or that they think talking about money is shameful and not patient-oriented. Most PMHNPs I talked to (even ones with years of experience) either don't care and/or don't know what kind of revenue they are bringing in. Many simply want a good steady salary (granted, PMHNPs do get good pay in general) with strong benefits and work-life balance (which means not seeing 30+ patients a day, although some do). Also keep in mind that psych nurses get paid pretty poorly, so that $130-160k PMHNP salary would seem pretty heavenly after you work a few years as a psych nurse making $25-35 an hour.

 

[Tom4705]

Take it from someone in psych, they don't see the same number or type of patients as psychiatrists. Our PMHNPs would typically see 12 patients per day, with 90 minute intakes, while psychiatrists would see 20 patients per day with 45 minute intakes.

Private Practice? I mean can't a PP NP see the same number of patients same time intakes and bill the insurance the same? I get it would be different in a hospital setting.

 

[Mad Jack]

Private Practice? I mean can't a PP NP see the same number of patients same time intakes and bill the insurance the same? I get it would be different in a hospital setting.

This is in an outpatient setting. There are very few NPs that have the skill or training to go through patients with the acuity and speed of a board certified psychiatrist. Literally half of the referrals our NPs got were sent to us because "this case is too complex, I don't feel safe managing it." Meanwhile I was cranking through 99214/99215 acuity patients very regularly because all the more challenging patients went to the physicians, while the NPs were spending a half hour per 99213. What all this boils down to is just because things are equal on paper, they are often not equal in practice because of the very different training and work styles of psychiatrists vs NPs.

 

[psychnurse]

Private Practice? I mean can't a PP NP see the same number of patients same time intakes and bill the insurance the same? I get it would be different in a hospital setting.

Absolutely. Plenty of PMHNPs see 3-4 patients an hour and do 30-min intakes. I was seeing 3 patients an hour as a new grad PMHNP and covering urgent care psych at a CHC, and the population is as complex as they come.

Bottom line, PMHNPs in OR can most certainly bill exactly the same as psychiatrists and make the same amount if they own their own private practice or work as a contractor taking a % of receipts.

 

[pamac]

I would agree with all of the above. Physicians tend to be able to crank out work, and are willing to do so. I’m one of those folks that went from nursing to NP, and am more into quality of work and home life vs the big money. Consequently, I’m all about the hour intake, and the half hour follow up. With the new billing that came out, a half hour of work with a patient is rarely a 99213, and instead becomes 99215 pretty easily, but you can’t do your code for straight time and then have your schedule booked for 20 minute appointments unless you want to invite some scrutiny. Being a coding wizard is great, but the docs and NPs immediately close to me don’t venture into that very much, perhaps because we are kind of lazy when it comes to that I guess. I’m sure it leaves money into the table, and I have friends running their own practices that squeeze out plenty more revenue. But billing for something, and being reimbursed often is a different thing as well.

The difference between a physician and an NP becomes clear when it comes to the pucker factor of working quickly with a hard case and doing it safely. But even my MD colleagues often want to be able to put in the half hour followups, but it doesn’t seem to be as critical to them operating safely like it does for me at this stage of my practice as an NP. I respect that off the top of their heads, MDs can keep rattling off alternatives and novel approaches. That’s residency and fellowship for you. Then comes the medical education background that comes into play for confounding illnesses and meds alongside the psyche issues. Plenty of things give me heartburn that a physician would just shrug off. Maybe in 10 years I’ll have shed some of my hesitancy, but it keeps me and my patient safe.

I do have NP friends in Oregon that make more than $300k working less than I do, and that has a lot to do with that law for billing parity. But I also would agree that most NPs don’t understand the money side of what we do. I know plenty of physicians that are clueless to that as well, but many of them compensate by simply working a lot more than I would want to. I really do seem to be surrounded by psychiatrists that HUSSLE. When they need some more cash flow, it’s not a challenge for them to find a place that will pay them quite a bit to do side work. In psyche it seems that everyone has side gigs of some sort. Lots of NPs I know have a couple jobs, and it’s not because they can’t find one place to settle down, it seems they just like variety. I have a side gig that I like, and that brings in decent wages.

 

[pamac]

I mentioned reimbursement, but it’s particularly true regarding NP run practices. In theory in most states that don’t have billing parity, an NP could command 85% of what a doc can, but you have to have a biller that can collect on that, and have to be paneled with insurance companies that will reimburse at decent rates. Or…. Be a cash only operation. The money in psyche often comes from having employees as well. So my psyche NP friends that have other NPs working for them, or counselors, or social workers, make the big money. Docs are more likely to be successful at setting something like that up. They get the loans, and often don’t have to hunt for business because it comes to them a lot quicker.

 

[Splenda88]

Absolutely. Plenty of PMHNPs see 3-4 patients an hour and do 30-min intakes. I was seeing 3 patients an hour as a new grad PMHNP and covering urgent care psych at a CHC, and the population is as complex as they come.

Bottom line, PMHNPs in OR can most certainly bill exactly the same as psychiatrists and make the same amount if they own their own private practice or work as a contractor taking a % of receipts.

Then you should demand pay parity. But the question is that why should they pay you 300k/year when they can hire someone else with more training for the same amount?

 

[pamac]

Then you should demand pay parity. But the question is that why should they pay you 300k/year when they can hire someone else with more training for the same amount?

Because there aren’t enough MDs in psyche to fill the need. When there are, then the price will go down. Where I’m at, even though I’m in a desirable locale, it’s still hard to find psychiatrists. And billing equally for NPs is often just a handout to the place of employment anyway…. A clinic hires a PMHNP for $170k, but they can bill for what a doc makes. Usually it’s docs or bigger entities that run those clinics, so they make more money on the backs of the NPs. The only way an NP makes the same wage is if they are running their own business, and then it’s a battle with insurance companies and billing. Nobody is paying NPs the same wage as physicians. But if an NP wants to go out and chase all that opportunity to equal bill, and jump all the hurdles, then it’s theoretically possible. Do I think a hospital anywhere in Oregon is like “well, I guess we are going to pay this NP as much as we would pay a doctor”? No. They will take the money and run, while paying the NP at least 50% less than a doc.

It’s the wrong question to ask if “NPs in Oregon are making as much as docs” because what NPs “make” depends on so many factors, particularly the employer, but also their own ability, efficiency, etc

 

[Tom4705]

Because there aren’t enough MDs in psyche to fill the need. When there are, then the price will go down. Where I’m at, even though I’m in a desirable locale, it’s still hard to find psychiatrists. And billing equally for NPs is often just a handout to the place of employment anyway…. A clinic hires a PMHNP for $170k, but they can bill for what a doc makes. Usually it’s docs or bigger entities that run those clinics, so they make more money on the backs of the NPs. The only way an NP makes the same wage is if they are running their own business, and then it’s a battle with insurance companies and billing. Nobody is paying NPs the same wage as physicians. But if an NP wants to go out and chase all that opportunity to equal bill, and jump all the hurdles, then it’s theoretically possible. Do I think a hospital anywhere in Oregon is like “well, I guess we are going to pay this NP as much as we would pay a doctor”? No. They will take the money and run, while paying the NP at least 50% less than a doc.

It’s the wrong question to ask if “NPs in Oregon are making as much as docs” because what NPs “make” depends on so many factors, particularly the employer, but also their own ability, efficiency, etc

Theoretically possible in the state of Oregon, I assume you mean.

 

[pamac]

Theoretically possible in the state of Oregon, I assume you mean.

More than theory… it’s happening. But the circumstances of those cases probably paint a different picture than one might expect. The ones who pull it off are likely to be NPs running their wine operation, which is a small minority. What that parity probably does is lead to better wages for the rest of NPs than they would get otherwise, but would probably not put them side by side with physicians.

 

[PikminOC]

This is in an outpatient setting. There are very few NPs that have the skill or training to go through patients with the acuity and speed of a board certified psychiatrist. Literally half of the referrals our NPs got were sent to us because "this case is too complex, I don't feel safe managing it." Meanwhile I was cranking through 99214/99215 acuity patients very regularly because all the more challenging patients went to the physicians, while the NPs were spending a half hour per 99213. What all this boils down to is just because things are equal on paper, they are often not equal in practice because of the very different training and work styles of psychiatrists vs NPs.

At least those NP know their limits and refer those cases out. It's not just about speed. You don't know what you don't know.

 

[MedJosh]

As a private practice psychiatrist in OR, it's actually not true that "pay parity" means paying NPs the same. Everyone negotiates rates and not even MDs make the same rate, let alone a NP. The rates I have negotiated are much higher than what they have offered the NP in my clinic if they get an individual contract. The pay parity is only for NP that are in the same clinic (or hospital) as a MDs. So the only way a NP can get the same rate as a MD is to work in a clinic with a MD where the MD always gets a cut. This will make disillusioned NPs mad, they think they are getting the same pay, but they are not by sometimes 20-30%. My NP get the rates I reimburse but if they went out on their own the rate drops. Rates are based on how big the group is, what specialty services you offer and how long you have been with the insurance company as well as relationships with the insurance rep. There is no law that states you have to pay everyone the same. It varies clinic to clinic, city to city. But whatever NPs tell themselves to feel better about offering second class services to the most vulnerable people.

 

[tinyhandsbob]

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